Questions to Ask a Midwife: Interview Checklist

Start with the basics: is she a Certified Nurse-Midwife (CNM), Certified Midwife (CM), or Certified Professional Midwife (CPM)? CNMs and CMs hold graduate degrees and can work in hospitals. CPMs train specifically for out-of-hospital birth.

Ask what year she graduated, where she trained, and whether she holds current certification with AMCB or NARM. Certification carries continuing education requirements. A state license is a separate thing: it sets what she is legally permitted to do, and that scope differs from state to state, so ask what her license covers where you live.

Ask whether she carries malpractice insurance. Requirements vary by state, and some insurers do not write policies covering home birth, so the answer tells you what recourse exists if something goes wrong.

Ask for total births attended and how many as the primary midwife. Someone who has attended 200 births as a student or assistant has different experience from someone who has managed 200 births herself.

Request her transfer rate, cesarean rate, and postpartum hemorrhage rate for the last year or two. Published figures give you a yardstick. In the MANA Stats cohort of 16,924 planned home births, 10.9 percent of women transferred during labor: 22.9 percent of first-time mothers and 7.5 percent of those who had given birth before. The Birthplace in England cohort reported 45 percent and 12 percent for the same two groups. If her numbers sit far outside that spread, ask her to explain how her client mix differs.

Ask if she has ever had a maternal death or infant death, and if so, what happened. This is uncomfortable but worth asking. How she answers tells you whether she takes responsibility and learns from bad outcomes.

Ask which hospital she transfers to and how long the drive takes from your address. Ask whether she has admitting privileges or a collaborative agreement with a physician there. If she has neither, you may be handed to whoever is on call, and she may not be permitted to stay with you.

Ask what share of her transfers are urgent versus non-urgent. In the MANA Stats cohort the most common reason for intrapartum transfer was failure to progress, not an emergency, but you want to hear that she can tell the difference.

Ask what happens to her fee if you transfer. Some practices refund a portion and some do not. Settle this before you sign a contract.

A study of 129 midwifery practices across 49 states found an average global fee of $4,650 and a median of $4,400, ranging from $2,000 to $9,921. The global fee covers prenatal care, delivery, and postpartum care. Where you live moves the number: the population-weighted average was $5,135.

That still leaves the details to pin down. Some practices bill separately for home visits, lab work, birth tub rental, or a birth assistant. Others include a birth kit. Ask for an itemized list of what sits inside the global fee and what you pay on top of it.

Ask about the payment schedule. Published fee pages commonly require payment in full by around 36 weeks, which means paying before the birth. Ask what portion is refundable if you transfer or give birth in a hospital.

What a midwife may carry and administer is set by state law, so open with what her license permits where you live. Home birth kits commonly include oxygen, IV fluids, medications used to manage postpartum hemorrhage, and newborn resuscitation equipment. Ask her to walk you through her birth bag and say which items she is licensed to use.

Ask how she monitors the baby's heart rate during labor, whether she uses a doppler or a fetoscope, how often she listens, and what would move her toward recommending transfer. Hearing her own protocol in her own words is the point.

Ask about her resuscitation training. NARM requires current CPR and Neonatal Resuscitation Program certification for CPMs to certify and recertify, so ask when she last recertified and what she would do if a baby did not breathe right away.

Most midwives bring an assistant or a second midwife. Ask about that person's training and role. Will they help with monitoring and exams, or set up supplies?

Ask whether she works in a practice with partners or solo. Solo midwives usually have a backup who covers illness, vacation, and overlapping births. Ask to meet that person before your due date.

Ask how many due dates she accepts in a given month and what happens when two clients labor at once. No published standard for client load exists, so what you are listening for is whether she has a stated limit and a plan. Ask what happens to the fee if she misses your birth, since some practices refund a portion.

This is where you find out whether her approach matches yours. Some midwives are hands-off and will not suggest position changes or techniques unless asked. Others are more directive. Neither is wrong, but the difference is worth establishing before you hire.

Ask what she offers for pain relief at home. Water, position changes, and counterpressure are common. Some practices also offer sterile water injections or nitrous oxide. If those matter to you, ask whether she provides them and at what cost.

Ask how she thinks about long labors and what would move her toward recommending transfer. Practices differ on this, and hearing her thresholds before labor beats discovering them during it.

Ask how many postpartum visits are included, when they happen, whether they are at your home or her office, and whether they sit inside the base fee.

ACOG recommends that postpartum care be an ongoing process rather than a single visit, with contact with an obstetric care provider within the first 3 weeks after birth and a full postpartum visit no later than 12 weeks. Ask how her schedule maps onto that.

Ask what she checks at those visits, for you and for the baby, and whether newborn screening is something she performs or refers out. Ask whether she is reachable by phone or text between visits and what her usual response time is.

Looking for a midwife in your state? Each state guide covers licensing, costs by region, Medicaid coverage, transfer hospitals, and what to ask before hiring. Start with: California, Texas, New York, Florida, Pennsylvania, Oregon, Washington, Colorado, Michigan, Georgia, Massachusetts, North Carolina, Utah, Vermont, Ohio, or browse all 50 states.